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Therapeutics P3 Spring > Geriatrics: Agitation > Flashcards

Geriatrics: Agitation Flashcards

1
Q

Neuropsychiatric symptoms (NPS)

A

Mild:
- depression
- anxiety
- irritability
- apathy

Severe:
- Agitation
- aggression
- vocalizations
- hallucinations
- delusions
- disinhibition

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2
Q

Delirium vs Dementia

A

Delirium -> acute onset
Dementia -> gradual onset

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3
Q

Medical causes of agitation in dementia

A

Medication
Infection
CVA
Trauma
Pain

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4
Q

Benefits of antipsychotics for NPS in dementia

A

very effective for hallucinations and delusions

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5
Q

Risks of antipsychotics for NPS in dementia

A

Increased mortality in elderly patients with dementia-related psychosis

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6
Q

Rank from most to least safe in geriatric patients: Haloperidol, Quetiapine, Olanzapine

A

Quetiapine > Olanzapine > Haloperidol

Quetiapine is “safer”, but still carries risks

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7
Q

Treatment for delusions and hallucinations

A

Aripiprazole*
Olanzapine*
Quetiapine*
Risperidone*
Clozapine (rarely used-blood dyscrasias)
Ziprasidone
Perphenazine
Haloperidol (acute/hospice use)
Fluphenazine
Thioridazine (anti-Ch)

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8
Q

Treatment for Parkinson’s Disease in geriatrics

A
  • visual hallucinations -> pharm treatment
  • significant emotional distress or dangerous / upsetting behavior

Quetiapine
Olanzapine
Pimavanserin (Nuplazid) $$$

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9
Q

Aripiprazole dosing + pearls

A

2-5 mg/d initially
max 30 mg/d
2nd gen

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10
Q

Olanzapine dosing + pearls

A

Hallucinations: 2.5-10mg/d
Parkinson’s: 2.5-5 mg/d
ADE: weight gain
2nd gen

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11
Q

Quetiapine dosing + pearls

A

Hallucinations: 25-800 mg/d
Parkinson’s: 12.5-75 mg/d
ophthalmic exam recommended Q6 months
2nd gen

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12
Q

Risperidone dosing + pearls

A

0.25 - 1 mg/d
dose-related EPS, IM not for acute treatment
do not exceed 6mg

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13
Q

Lewy Body Dementia

A
  • cognitive decline accompanied by motor features of parkinsonism
  • Prominent visual hallucinations
  • avoid conventional antipsychotics: haloperidol, thioridazine, fluphenazine
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14
Q

Depressive symptom management

A

Non-pharm: recreational programs, activity therapies

Meds:
- SSRIs (citalopram, escitalopram, fluoxetine, sertraline)
- SNRIs (desvenlafaxine, duloxetine, venlafaxine)
- Mirtazapine
- Trazadone
- Bupropion

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15
Q

Meds not to use for depressive symptoms in geriatric patients

A

Paroxetine
Desipramine
Nortriptyline

Anticholinergic ADEs!

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16
Q

Citalopram dosing + pearls

A

10-40mg
ADE: EPS, hyponatremia, GI upset, nausea, upper GI bleeds, suicide, insomnia

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17
Q

Escitalopram dosing + pearls

A

5-20mg
ADE: EPS, hyponatremia, GI upset, nausea, upper GI bleeds, suicide, insomnia

18
Q

Fluoxetine dosing + pearls

A

10-40mg
ADE: EPS, hyponatremia, GI upset, nausea, upper GI bleeds, suicide, insomnia
Long half-life
more insomnia

19
Q

Sertraline dosing + pearls

A

25-100mg
ADE: EPS, hyponatremia, GI upset, nausea, upper GI bleeds, suicide, insomnia
Hypomania

20
Q

Desvenlafaxine dosing + pearls

A

50mg
ADE: nausea, HTN, dry mouth, headaches, dizziness
indicated for depression only

21
Q

Duloxetine dosing + pearls

A

20-60mg
ADE: nausea, dry mouth, dizziness, HTN, renal dose adjustments
indicated for depression + diabetic neuropathy

22
Q

Venlafaxine dosing + pearls

A

25-100mg
ADE: HTN, QTc prolongation, EPS, withdrawal sx, hyponatremia, insomnia
useful in severe depression / anxiety

23
Q

Bupropion dosing + pearls

A

75-225 mg
ADE: irritability, insomnia, can lower seizure threshold
more activating
lack of cardiac and sexual ADEs

24
Q

Mirtazapine dosing + pearls

A

5.5-225 mg
ADE: sedation, hypotension, may increase appetite
useful for depression + insomnia or weight loss

insom-nom-nom-nomia

25
Q

Trazodone dosing + pearls

A

25-150mg
ADE: sedation, falls, hypotension
When sedation is desirable

26
Q

Apathy treatment

A
  • methylphenidate
  • dextroamphetamine
  • modafanil
27
Q

Manic-like behavioral sx treatment

A

Divalproex sodium *
Carbamazepine
Lamotrigine
Lithium

28
Q

Divalproex sodium dosing + pearls

A

250-2,000 mg/d
ADE: nausea, GI upset, ataxia, sedation, hyponatremia
CBC, platelet, LFT at baseline + Q6M

Available in sprinkle cap
Better tolerated than other mood stabilizers

29
Q

Carbamazepine dosing + pearls

A

200-1,000 mg/d
ADE: nausea, fatigue, ataxia, blurred vision
poor tolerability in older adults

30
Q

Lamotrigine dosing + pearls

A

25-200 mg/d
ADE: Skin rash, SJS, dizziness, sedation, neutropenia, anemia
increased ADE when used with divalproex

31
Q

Lithium dosing + pearls

A

150-1,000 mg/d
ADE: nausea, vomiting, tremor, confusion, leukocytosis, gait ataxia
Poor tolerability in older adults
narrow therapeutic window

32
Q

Agitation / Aggression secondary to: Psychosis

A

Aripiprazole
Olanzapine
Quetiapine
Risperidone

33
Q

Agitation / Aggression secondary to: Depression

A

SSRIs

34
Q

Agitation / Aggression secondary to: Anxiety

A

Buspirone (2-4 week trial)
Trazodone

35
Q

Agitation / Aggression that is unresponsive to 1st line therapy

A

Divalproex sodium
Carbamazepine
IM Olanzapine

36
Q

Agitation / Aggression with sexual aggression

A

Aripiprazole
Olanzapine
Quetiapine
Risperidone
Divalproex sodium
Conjugated equine estrogens
Medroxyprogesterone injectable

37
Q

Sundowning sx

A

Forgetful, confused, delirious, agitated, anxious, restless

Insomnia w/ pacing, wandering, yelling, combativeness

38
Q

Sundowning non-pharm treatment

A

Night lights
check ins

39
Q

Sundowning acute pharmacologic treatment

A

Trazodone
1st gen APS
2nd gen APS

(do not use quetiapine in insomnia without sundowning or hallucinations)

40
Q

Sundowning long term pharm treatment

A

Trazodone
Melatonin
2nd gen APS
1st gen APS

41
Q

Insomnia acute treatment

A

Trazodone
Melatonin
BZDs
Mirtazapine

42
Q

Insomnia long term treatment

A

trazodone
melatonin

Therapeutics P3 Spring (32 decks)

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